Purpose
To describe a case of interlamellar keratitis induced by elevated intraocular pressure (IOP) in a patient with a history of LASIK surgery and the importance of having a strong diagnostic ...suspicion for establishing adequate treatment.
Methods
Intraocular pressure‐induced interlamellar keratitis is one of the potential complications of LASIK refractive surgery. The cases described generally occur a few months after surgery although there are some cases that have been described several years after surgery, usually in a context of uveitis and corticosteroid treatment or silent glaucoma. We present a case of 43‐year‐old woman who came to the emergency room with visual acuity (VA) impairment in the left eye in the setting of elevated intraocular pressure‐induced interlamellar keratitis secondary to the intravitreal corticosteroid implant in her left eye due to a diabetic retinopathy. She underwent LASIK surgery 14 years ago.
Results
The treatment was based on lowering the intraocular pressure. Oral acetazolamide and topical timolol, bimatoprost and brinzolamide were used. The patient recovered her baseline VA and the IOP were properly controlled posteriorly.
Conclusions
This case shows the importance of considering this diagnosis in patients with corneal haze, elevated intraocular pressure and a history of LASIK surgery to establish an adequate treatment. A full recovery is expected.
Bibliography
1. Galal A, Artola A, Belda J, (2006) Interface corneal edema secondary to steroid‐induced elevation of intraocular pressure simulating diffuse lamellar keratitis. Journal of refractive surgery.
2. Lee V, Sulewski M, Zaidi A (2010) Elevated Intraocular Pressure–Induced Interlamellar Stromal Keratitis Occurring 9 Years After Laser In Situ Keratomileusis. Corneal Journal.
3. Lyle W, Jin G, Jin Y (2003) Interface fluid after laser in situ keratomileusis. Journal of refractive surgery.
4. Tourtas T, Kopsachilis N, Meiller R, et al. (2010). Pressure‐Induced Interlamellar Stromal Keratitis After Laser In Situ Keratomileusis. Corneal Journal.
Gonococcal conjunctivitis: a case report Lopez Sangros, Isabel; Marco Monzón, Sara; Karlsruher Riegel, Gisela ...
Acta ophthalmologica,
December 2019, 2019-12-00, 20191201, Letnik:
97, Številka:
S263
Journal Article
Recenzirano
Odprti dostop
Purpose
A case report of ocular perforation secondary to gonococal queratoconjunctivitis is presented.
Methods
A 49 year old man visited the Emergency Departement with redness, pain, and purulent ...secretion in his left eye of four days of evolution. He related a risky sexual relationship in the days before the clinic appeared, with direct inoculation of vaginal secretions in his left eye. At the slit lamp examination, he presented a significant corneal thining with ocular perforation in the upper part of the cornea. The direct microscopic examination of ocular secretions showed the presence of gram negative diplococci.Treatment with intravenous ceftriaxone, and topic ceftazidime was instaured. The patient underwent an urgent surgical intervention with a superior conjunctival covering of the upper of the cornea.
Results
The evolution of the patient was favorable with surgical treatment and antibiotic therapy. The results of the culture of ocular secretions confirmed the growth of Neisseria gonhorreae. One month later, the patient underwent a penetranting keratoplasty and a phacoemulsification with intraocular lens implant in the posterior chamber. At the moment, the patient is stable without corneal reject signs and a visual acuity of 1/10 with his left eye.
Conclusion
Gonococal queratoconjunctivitis is a serious infection that can cause significant corneal thining and ocular perforation. The incidence of this disease has increasead in the last years. For this reason it is important to make a differential diagnosis in presence of purulent queratoconjunctivitis asociated with risk factors.
To report the utility of tacrolimus 0.03% dermatologic ointment (Protopic) in a case of refractory atopic keratoconjunctivitis with giant papillae. A review of the medical literature is presented.
A ...32-year-old man with a long-standing history of severe atopic disease was referred to our department because of bilateral intense eye pain, itching, photophobia, and epiphora. Biomicroscopy examination showed conjunctival hyperemia, superficial punctata keratitis, and tarsal giant papillae. This patient had undergone previous treatment with systemic and topical steroids, antihistamines, topical antihistamine/mast cell stabilizer drops, cyclosporine A, and even surgical resection-cryopexy of giant papillae-without success.
The patient was started on tacrolimus 0.03% ointment treatment of the conjunctival fornix twice daily. After 2 months, the patient experienced resolution of his clinical symptoms with a significant decrease in papillae size. No side effects were reported. Treatment was continued for 1 month and gradually reduced with increasingly wide intervals between applications. Eight months after treatment, there were no signs of reactivation, and the patient remains asymptomatic.
Application of tacrolimus 0.03% dermatologic ointment into the lower fornix seems to constitute an interesting alternative treatment for atopic keratoconjunctivitis that is refractory to traditional treatment.
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